Provider Demographics
NPI:1033582333
Name:MLS HOMEMAKER/COMPANION SERVICE
Entity Type:Organization
Organization Name:MLS HOMEMAKER/COMPANION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGNOLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-603-0126
Mailing Address - Street 1:1406 COUNTY ROAD 228
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-8507
Mailing Address - Country:US
Mailing Address - Phone:352-571-0492
Mailing Address - Fax:
Practice Address - Street 1:1406 COUNTY ROAD 228
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:352-571-0492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233935253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015196100Medicaid